Tuesday, February 4, 2014

New Plan Regarding Cancer

France has just announced a plan to "reduce inequalities in the face of cancer." This has an admirably republican ring to it, but what does it actually mean?
Le plan vise à réduire le délai moyen d'attente pour obtenir un examen par IRM pour bénéficier d'un diagnostic. Actuellement de 27 jours, il devra passer à 20 jours maximum sur l'ensemble du territoire.
The subject is of more than usual interest to me because I was diagnosed with cancer in the fall of 2012. My first MRI came within 2 days of the initial tentative diagnosis. In the course of my treatment, the intense phase of which lasted about 3 months, I had 3 PET scans and a dozen more MRIs in conjunction with fractionated radiation therapy. (The treatment was successful, in case you're wondering.)

To a patient like me, 20 days sounds like a very long time to wait for an MRI. No doubt that's an average across all uses of MRI, and the rationing would be different for a patient undergoing intense radiotherapy. Still, I wonder what my situation would have been had I been in France. When I hear comparisons of the French and American medical systems, I wonder how fine-grained the comparisons are. It's true that American medicine is horribly expensive, but when you're sick, it's awfully nice to have an abundance of resources at your disposal.

Forgive me for abandoning my preferred sober analytic approach. In this instance I think I'm entitled to express gratitude, even if I have to concede that anecdote is not evidence and it would be wrong to draw any sweeping conclusions from my individual experience.


George Ross said...

Art Your comments, alas, may indicate some of the tradeoffs that come with today's democratic national health insurance programs. Expensive treatments get rationed, and the triage that then comes into play may treat people unequally in different ways at big personal costs to many folks. I'm no expert, but there must be comparative data on these things. In the US, where I, like you, had a very good health plan, I never waited for anything. In Canada, where I am these days, you wait if your problem is not life-threatening (and perhaps in some cases, where it may be). You need a new hip, to get cataracts removed, to have expensive but preventive tests, and the like, you wait. Jane and I just did an experiment. Both of us had to have the same test, and because we have a vacation house in the forest, we chose the hospital in the small city near this house, rather than Montreal, because the wait times were very, very different. The French system has just been revoted number 1 in the world by the WHO, but it clearly has the same scary triage issues. Worth thinking more about, given the inevitability of more budget squeezing.

FrédéricLN said...

Art: oh! Glad to know the cure worked fine.

Mitch Guthman said...


I had feared as much based on your cryptic comments at the time. I am greatly relieved that you have regained your health.

The only defense I would make about the French system in comparison with our own is that they achieve much better results overall (including cancers) at a much lower costs. It is universal, reasonably priced and a major illness doesn't result in bankruptcy and impoverishment for people without top drawer, employer paid insurance.

The main difference is the in universal health care systems like that of France and England, triage is performed on the basis of medical necessity, whereas in America we have triage based on wealth.

PF said...

(Art, very glad to know your treatment and recovery has proceeded well!)

Policy-wise, my rough understanding was that the national health insurance systems in advanced countries mainly set out a baseline standard for comprehensive coverage and access. And then those who want to spend their disposable income on further enhanced (privately-offered) forms of insurance with more coverage and perhaps better access can do so. In France, would this (capitalist, not democratic) aspect mitigate the problem for some faction of people?

brent said...

"when you're sick, it's awfully nice to have an abundance of resources at your disposal."

Like others, I am very grateful for the care you received, Art, and your good results. As someone who dwells in roughly the same health-care universe as you, I too feel relieved to have an "abundance of resources," such as comprehensive insurance and outstanding medical centers, at my disposal.

But let's not kid ourselves that this is "American medicine." You and I dwell in an elite, upper percentile for health care access. A much larger fraction of Americans have no access at all other than the ER, and a still larger fraction are using the very limited resources of Medicaid. Furthermore, the vast majority of 'insured' people would have such large deductibles and co-payments that the sort of treatments you describe would cost them tens of thousands of dollars out of pocket and very likely bankrupt them. That's 'American medicine' for the large majority, and the ACA will only marginally improve things. By that measure I'm guessing the French system--and every other national system in an advanced economy-- looks HUGELY superior.

Art Goldhammer said...

I'm really not sure. I didn't mean to imply that my care was representative of "American medicine," but I think the picture you draw is a bit of a caricature. I encountered quite a few people on my course through treatment, and by no means all of them were from the 1% or the 10% or even the 50%. Boston is indeed exceptional, but there are other top-rank cancer centers around the country, and I met people who traveled long distances to get the treatment they needed, as they would have had to do in France as well. I wonder if anyone has done a careful comparison. Recommendations?

Mary Campbell Gallagher said...

Art, As one of those who picked up on your illness at the time, I too feel relief.